Acute Cholecystitis: Preoperative CT Can Help the Surgeon Consider Conversion from Laparoscopic to Open Cholecystectomy

Fuks, David; Mouly, C.; Robert, B.; Hajji, Hassene; Yzet, Thierry; Régimbeau, Jean-Marc

doi:10.1148/radiol.12110460

Cited by 66 publications

(40 citation statements)

References 20 publications

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“…Pericholecystic fluid on ultrasound was a predictor in one study [48] , but not in 2 other studies [40,42] . However, when evaluated on CT, the same measures were not risk factors [31] .…”

Section: Medical Imagingmentioning

confidence: 92%

“…Meta-analysis on 3 of these studies [11,31,33] (n = 20,748, median NOS = 8 (range 7-9), I 2 = 74%) found a pooled OR of 1.85 (95% CI 0.92-3.75; fig. 2 c).…”

Section: Gendermentioning

confidence: 99%

“…ASA-Score ASA-score was evaluated as a risk factor for conversion in 6 studies [4,9,11,29,31,38] . Of these, only 2 studies [11,38] found a higher ASA-score to be a risk factor for conversion.…”

Section: Gendermentioning

confidence: 99%

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Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

et al. 2016

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Background: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery. Methods: PubMed and Embase were searched systematically in March 2014. Observational studies evaluating preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery in patients with gallstone disease were included. The outcome variables extracted were patient demographics, medical history, severity of gallstone disease, and preoperative laboratory values. Results: A total of 1,393 studies were screened for eligibility. We found 32 studies, including 460,995 patients operated with laparoscopic cholecystectomy, eligible for the systematic review. Of these, 10 studies were suitable for 7 meta-analyses on age, gender, body mass index, previous abdominal surgery, severity of disease, white blood cell count, and gallbladder wall thickness. Conclusions: A gallbladder wall thicker than 4-5 mm, a contracted gallbladder, age above 60 or 65, male gender, and acute cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery.

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“…Pericholecystic fluid on ultrasound was a predictor in one study [48] , but not in 2 other studies [40,42] . However, when evaluated on CT, the same measures were not risk factors [31] .…”

Section: Medical Imagingmentioning

confidence: 92%

“…Meta-analysis on 3 of these studies [11,31,33] (n = 20,748, median NOS = 8 (range 7-9), I 2 = 74%) found a pooled OR of 1.85 (95% CI 0.92-3.75; fig. 2 c).…”

Section: Gendermentioning

confidence: 99%

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Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

et al. 2016

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“…Furthermore, CT has been advocated as a useful modality in preoperative planning, with the absence of gallbladder wall enhancement and/or the presence of a stone within the infundibulum associated with conversion from laparoscopic to open cholecystectomy. Prior knowledge of these imaging findings may therefore help guide the appropriate surgical approach [20]. …”

Section: Summary Of Literature Reviewmentioning

confidence: 99%

ACR Appropriateness Criteria Right Upper Quadrant Pain

Yarmish

Smith

Rosen

et al. 2014

Journal of the American College of Radiology

102

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Acute right upper quadrant pain is a common presenting symptom in patients with acute cholecystitis. When acute cholecystitis is suspected in patients with right upper quadrant pain, in most clinical scenarios, the initial imaging modality of choice is ultrasound. Although cholescintigraphy has been shown to have slightly higher sensitivity and specificity for diagnosis, ultrasound is preferred as the initial study for a variety of reasons, including greater availability, shorter examination time, lack of ionizing radiation, morphologic evaluation, confirmation of the presence or absence of gallstones, evaluation of bile ducts, and identification or exclusion of alternative diagnoses. CT or MRI may be helpful in equivocal cases and may identify complications of acute cholecystitis. When ultrasound findings are inconclusive, MRI is the preferred imaging test in pregnant patients who present with right upper quadrant pain. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

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“…Preoperative prediction of patients at risk of conversion can be very useful for surgical planning and outcomes (21). In the radiology literature, a recent study by Fuks et al reported imaging findings on CT that can predict conversion (22). With the additional functional information, GDE-MRC may be helpful in risk stratification of the patients and in preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the gallbladder and cystic duct patency with gadoxetate disodium enhanced MR cholangiography: prospective comparison of patients with normal gallbladder function and acute cholecystitis

et al. 2015

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Acute Cholecystitis: Preoperative CT Can Help the Surgeon Consider Conversion from Laparoscopic to Open Cholecystectomy

Abstract: The absence of gallbladder wall enhancement (associated with the presence of gangrenous acute cholecystitis) and the presence of a gallstone in the gallbladder infundibulum are associated with conversion from laparoscopic to open cholecystectomy.

Cited by 66 publications

References 20 publications

Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

ACR Appropriateness Criteria Right Upper Quadrant Pain

Evaluation of the gallbladder and cystic duct patency with gadoxetate disodium enhanced MR cholangiography: prospective comparison of patients with normal gallbladder function and acute cholecystitis

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